Setting 45 public secondary schools from four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein).

Participants A total of 3444 students from 172 classes with a mean age of 10.37 years (SD=0.59) and 47.9% girls at baseline. Analysis
sample with follow-up up data merged to baseline data comprises 2513 datasets (73%).

Intervention ‘Eigenständig werden 5+6’, a school-based prevention programme for grades 5 and 6 to enhance substance-specific and general
life skills, consisting of 14 units (à 90 min) and two workshops (4–6 h) being taught over a time period of 2 school-years
by trained teachers.

Outcome measures Lifetime and current smoking, incidence of smoking in baseline never smokers, smoking-related knowledge, attitudes, perceived
norms of smoking and self-efficacy to refuse cigarette offers were assessed in students.

Results 6 months after the end of programme implementation, students of intervention classes showed significantly lower rates for
lifetime smoking (adjusted OR=0.63; 95% CI 0.41 to 0.96; p=0.026) and incidence of smoking (adjusted OR=0.66; 95% CI 0.43
to 1.00; p=0.047), a higher increase of smoking-related knowledge (adjusted β=9.38; 95% CI 6.73 to 12.04; p<0.001) and a greater
change in attitudes towards a more critical perception of risks and disadvantages of smoking (adjusted β=0.10; 95% CI 0.03
to 0.16; p=0.002). No group differences were found for current smoking, perceived norms of smoking and self-efficacy to refuse
cigarette offers.

Conclusions Participation in the school-based prevention programme ‘Eigenständig werden 5+6’ may have small effects on smoking behaviour
and attitudes and a moderate effect on smoking-related knowledge.

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